Does growth hormone treatment advance bone age?

Abstract

Introduction: Growth hormone (GH) treatment may have a stimulatory effect on bone maturation which raises concern about acceleration of bone maturation leading to early epiphyseal fusion. In this study, we aimed to investigate this possibility and determine whether or not accelerated bone maturation affects predicted or final height.Methods: A total of 230 patients who received GH treatment between 1995 and 2005 were retrospectively studied. The patients were classified as isolated growth hormone deficiency (GHD) (Group-1), Turner syndrome (Group-2), and others (Group-3). The previous X rays were obtained from the medical records and follow-up X rays were requested during the clinic visit. Bone age (BA) assessment was done according to the atlas of Greulich and Pyle. Based on BA, adult height prediction was calculated by the method of Bayley and Pinneau. The predicted height (PH) at baseline and after the first and second years of treatment were evaluated along with the change in chronological age (CA)-BA and CA/BA.Results: Height SDS significantly increased in all three groups (p<0.05). CA-BA decreased in Groups-1 and 2 during the first and second years of treatment (p<0.05). The BA acceleration was verified by the decrement in CA/BA ratio. However, predicted height was not negatively influenced despite BA advancement.Discussion and Conclusion: BA advances with GH treatment as evident from the reduction in CABA and CA/BA. However, predicted height is not adversely affected by accelerated bone maturation in our cohort over two years of treatment. This issue needs to be investigated in other patient groups such as precocious puberty where bone maturation is further accelerated.